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FEE :WORKSIILGY PER EACH FIICILI* <br /> UBA ADDRESSY c27J5 9 /Vl� yy 11rd. _ oC/< o%l <br /> MAILING ADDRESS O <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> 0b. Additional Tanks (N Additional Tanks x $50) <br /> 2 State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) �� O <br /> ($56 x Total M ( Tanks) <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (M_ Temporary closures x $80) (See above A3 to calculate surcharge) <br /> 4 . *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using Lank . <br /> (p_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> �'.moo`°•00 <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) $150 <br /> la. Existing Facility & 1st Tank 150 <br /> b. 3 Additional Tanks x $50 <br /> 224 <br /> 2. State Surcharge, 4 Tanks x $56 — <br /> Total Number of Tanks 4 <br /> Total Fee Due $524 <br /> *troth closures will be conditioned. Contact a Health District Representative. <br /> � I <br />